The practice of evidence-based audiological (re)habilitation requires efficient, easy to use, standardized outcome assessment protocols and instruments with known reliability and validity. Such protocols and instruments are especially important for assessing the speech communication benefits of cochlear implants (CIs) in adults and children. The standard of care for treatment of severe-profound hearing impairment is bilateral implantation. Thus, these protocols and instruments must also include the capability of assessing binaural hearing abilities. Current techniques require specially controlled sound environments. Previous research and development efforts with the Hearing In Noise Test (HINT) (Nilsson et al., 1994) have produced a binaural speech communication assessment protocol and instrument for sound field (SF) evaluation of acoustic hearing adults and children as young as six years of age. The protocol can also be administered to adults with earphones, using a virtual audio simulation of the SF test conditions. The specific objective of the proposed research is to extend the use of the HINT virtual audio simulation to pediatric populations. In Phase I, this simulation will be implemented for acoustic testing of normally hearing and hearing impaired children as young as six years of age. The pediatric assessment protocol will be administered in the SF and with insert earphones (IP). The IP signals will be processed with a virtual audio simulation that will be adapted from the adult simulation to compensate for differences in head size and geometry that affect acoustic cues for binaural hearing. In Phase II, the virtual audio simulation developed and validated in Phase I will be extended for use with pediatric cochlear implant (CI) recipients. A pediatric CI assessment protocol and prototype instrument will be developed and validated at multiple clinical centers. PUBLIC HEALTH RELEVANCE: The proposed research will produce an innovative and technologically advanced computer-based instrument that will resolve many of the practical problems encountered when attempting to assess speech intelligibility and binaural hearing abilities in pediatric patients.